Doctor’s orders: a prescription for income security

Dr. Andrew Pinto, a physician with the St. Michael’s family health team, has long known that income plays a large role in a
person’s health. Despite strong evidence linking the two, however, it’s not seen as the health system’s job to address

“What if we were able to ‘prescribe’ income to our patients who need it most?” said Dr. Pinto. “How would that impact their health conditions and their use of the health system?”

Dr. Pinto is studying a novel health intervention – a dedicated member of the health team who focuses on improving the income security of patients living in poverty. With colleagues at the Centre for Research on Inner City Health and the Applied Health Research Centre, he received support from the TD Financial Literacy Grant Fund and the AFP Innovation Fund to conduct the IGNITE (addressInG iNcome securITy in primary carE) study.

“Poverty is a medical risk factor,” he said. “I hope to examine what we health providers can do in our practices. Additionally, I think the results of IGNITE can help inform policy makers about future interventions to address poverty as a health issue.”

With funding from the Ministry of Health, Karen Tomlinson was hired in November to work with the family health team. She is possibly Canada’s first full-time “health promoter” whose specific focus is to help patients improve their financial situation. She will help patients referred to her by doctors to navigate the government’s social services system, including programs such as Ontario Works and the Ontario Disability Support Program. She will also help patients reduce expenses, complete their taxes, set up bank accounts, access free programs, budget and save for emergencies.

“There are social workers and community resources and support programs, but this intervention is a first of its kind in that it’s at the individual level to improve income as a social determinant of health,” said Dr. Gary Bloch, a family physician and chair of the Social Determinants of Health Committee in the Department of Family and Community Medicine.

The example Dr. Pinto provides is of a husband and father in his mid-50s who suffered a major health issue. He was making minimum wage and had no benefits. He can’t return to work because he can’t do the manual labour. He’s under immense stress because he can’t make ends meet for his family, let alone buy his medications. As a newcomer to Canada, he is finding it hard to navigate the social assistance system. Dr. Pinto’s study aims to learn whether a health promoter such as Tomlinson could improve his income, his prospects for returning to employment and his health.

“If he were my patient, I’d let him know about his options to apply for the Ontario Disability Support Program, which could help him develop a modified return to work program, or perhaps applying for Ontario Works,” said Tomlinson. “Everyone I’ve met with wants to work. Their idea is not to take advantage of the system. If I can help these people become independent and healthy again, everyone wins because poverty costs the system more in the long-term.”

About St. Michael's Hospital

St. Michael’s Hospital provides compassionate care to all who enter its doors. The hospital also provides outstanding medical education to future health care professionals in 27 academic disciplines. Critical care and trauma, heart disease, neurosurgery, diabetes, cancer care, care of the homeless and global health are among the hospital’s recognized areas of expertise. Through the Keenan Research Centre and the Li Ka Shing International Healthcare Education Centre, which make up the Li Ka Shing Knowledge Institute, research and education at St. Michael's Hospital are recognized and make an impact around the world. Founded in 1892, the hospital is fully affiliated with the University of Toronto.